Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $56.39 / $171.01 / $309.27	Facility	26	$56.39	$171.01	$309.27
Aetna Facility/Professional Professional Modifier Low / Median / High Price $117.70 / $346.73 / $4,915.53	Professional		$117.70	$346.73	$4,915.53
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $57.28 / $280.54 / $990.00	Professional	26	$57.28	$280.54	$990.00
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $59.80 / $104.48 / $458.36	Professional	TC	$59.80	$104.48	$458.36
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $193.25 / $199.05 / $204.85	Facility	26	$193.25	$199.05	$204.85
Cigna Facility/Professional Professional Modifier Low / Median / High Price $247.73 / $297.08 / $371.37	Professional		$247.73	$297.08	$371.37
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $121.27 / $140.40 / $175.50	Professional	26	$121.27	$140.40	$175.50
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $126.43 / $156.69 / $195.86	Professional	TC	$126.43	$156.69	$195.86
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $112.43 / $207.64 / $503.50	Professional		$112.43	$207.64	$503.50
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $56.25 / $91.38 / $314.38	Professional	26	$56.25	$91.38	$314.38
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $56.18 / $96.24 / $265.97	Professional	TC	$56.18	$96.24	$265.97
Medica Facility/Professional Facility Modifier 26 Low / Median / High Price $199.05 / $199.05 / $199.05	Facility	26	$199.05	$199.05	$199.05
Medica Facility/Professional Professional Modifier Low / Median / High Price $139.13 / $233.49 / $701.25	Professional		$139.13	$233.49	$701.25
Medica Facility/Professional Professional Modifier 26 Low / Median / High Price $65.94 / $83.01 / $855.01	Professional	26	$65.94	$83.01	$855.01
Medica Facility/Professional Professional Modifier TC Low / Median / High Price $67.14 / $101.44 / $724.87	Professional	TC	$67.14	$101.44	$724.87
Midlands Facility/Professional Facility Modifier 26 Low / Median / High Price $199.05 / $204.85 / $337.02	Facility	26	$199.05	$204.85	$337.02
Midlands Facility/Professional Professional Modifier Low / Median / High Price $237.15 / $283.00 / $373.19	Professional		$237.15	$283.00	$373.19
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $59.07 / $109.26 / $210.04	Professional		$59.07	$109.26	$210.04
United Facility/Professional Professional Modifier Low / Median / High Price $131.76 / $164.42 / $261.85	Professional		$131.76	$164.42	$261.85
United Facility/Professional Professional Modifier 26 Low / Median / High Price $62.92 / $78.05 / $115.68	Professional	26	$62.92	$78.05	$115.68
United Facility/Professional Professional Modifier TC Low / Median / High Price $67.14 / $86.55 / $142.99	Professional	TC	$67.14	$86.55	$142.99
Wellmark Facility/Professional Professional Modifier Low / Median / High Price $185.02 / $234.20 / $275.50	Professional		$185.02	$234.20	$275.50
Wellmark Facility/Professional Professional Modifier 26 Low / Median / High Price $88.64 / $112.20 / $132.00	Professional	26	$88.64	$112.20	$132.00
Wellmark Facility/Professional Professional Modifier TC Low / Median / High Price $96.38 / $122.00 / $143.60	Professional	TC	$96.38	$122.00	$143.60